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Every child will, at some point, scrape a knee, cut a finger or break their skin open in some way. While more serious lacerations require medical attention, here are some basic tips for assisting in the healing of minor cuts and avoiding infection or irritation.

First aid for minor cuts and abrasions

• Before treating a child’s injuries it is important to first wash your own hands, covering any breaks in the skin with bandages or gloves.
• Generally speaking, shallow cuts and abrasions stop bleeding on their own. However, if bleeding persists, it may be necessary to physically stem the flow of blood by gently holding a sterile dressing to the wound and applying pressure.
• Gently, but thoroughly, cleanse the cut with fresh water, dabbing lightly with a clean cloth to dry. Stubborn debris can be removed using a damp cloth or sterile tweezers.
• Apply an antibiotic ointment (such as iodine) to kill any bacteria which may have gotten into the wound.
• Cover the cut with a sterile bandage, this stops germs from getting in and also protects the wound from further irritation. Any dressings should be kept dry, clean and be changed regularly.
• Monitor the injury to make sure it is healing properly. Redness, swelling, pus, pain or warmth may all be signs that the wound has become infected; this usually requires treatment with antibiotics by your doctor.

Severe injury

Deep lacerations or wounds may require more extensive treatment, including prolonged pressure, elevation of the affected body part and specialist medical attention. In the case of wide, deep or long wounds that will not stop bleeding, seek immediate medical assistance.

Closing wounds

It is important to properly clean a cut as soon as possibleIn the case of wounds that are particularly deep, open or have body tissue sticking out the doctor may be required to physically close the wound using a variety of methods. Adhesive butterfly strips are often sufficient to hold together small cuts. Gaping wounds may need cyanoacrylate glue, staples or stitches (sutures) to close them up properly.

Tetanus shots

Tetanus is a type of infection which causes severe, potentially fatal, muscle spasms; it is caused by the bacteria Clostridium tetani . The bacteria can infect deep cuts and wounds, thus it is recommended that a tetanus vaccination be given every 10 years. If a wound was caused by a dirty or rusty object (such as a nail or tin), gets dirty, or is particularly deep, and your last tetanus shot was not within the last 5 years, your doctor may suggest a booster.

References

Children’s Hospital Colorado 2011, ‘Checking Out Cuts, Scatches, and Abrasions’, retrieved 6 September 2011, <http://www.childrenscolorado.org/wellness/info/kids/10350.aspx>.

Mayo Clinic 2009, ‘Cuts and scrapes: First aid’, retrieved 6 September 2011, <http://www.mayoclinic.com/health/first-aid-cuts/FA00042>.

St John Ambulance 2004, ‘FACT SHEET: First aid in and around the Home’, retrieved 6 September 2011, <http://www.stjohnnsw.com.au/mc/fs/fs_aidhome1.html>.

Burns are injuries to the skin caused by heat from flames, liquids, radiation, chemicals or electrical devices. The severity of a burn is determined by its depth, the age of the patient, the particular sites on the body burnt (hands, feet, face, genitals and joints are the most complicated) and the total surface area of the burns. While minor burns usually cause nothing more than temporary shock and mild discomfort, severe or widespread burns can be physically destructive, permanently debilitating and even fatal.

Types of burns

Burns can be classified by the depth of tissue they injure. The names for various types of burns have changed over the years.Superficial burn – previously known as first-degree burns, these are minor burns which affect only the outer layer of skin, the epidermis. They may become red, inflamed and painful, but generally heal within 10 days with no scarring.

Partial thickness – these burns (formerly second-degree) damage the middle layer of skin called the dermis. The dermis is much thicker than the epidermis so the severity of these burns can vary depending on their depth. Often red and/or white in colour with blisters, partial thickness burns can take several weeks to heal and often leave scarring.

Deep full thickness – burns which penetrate the entire width of the skin, down through the epidermis, dermis and hypodermis, are classified as full thickness, or third-degree. When the hypodermis is injured, other elements contained within this layer, such as hair follicles, sweat glands and nerve cells, are also destroyed. Skin which has incurred a full-thickness burn may be white or charred and surrounded with large blisters. These typically require skin grafts and usually leave considerable scarring.

Full thickness with injury to underlying tissue – sometimes this fourth classification (fourth-degree burn) is used to describe a burn which involves the loss of all three layers of the skin, plus underlying muscles, ligaments or bone. These types of burns are frequently life-threatening; they regularly cause permanent physical impairment or require amputation.

Basic first aid for minor burns

Basic first aid and at-home care is usually sufficient for treating children who receive a first degree burn on a small portion of their body.Basic first aid and at-home care is usually sufficient for treating children who receive a first degree burn on a small portion of their body:

• Stop the child’s skin from burning. This could mean removing the source of the burns (chemical, electrical or putting out a fire) or taking the child out of the situation.
• Soak the burnt area of skin or place it under cold running water immediately. Continue to cool the skin for 10-20 minutes; this stops the skin burning, minimises pain and reduces the resultant inflammation.
• Remove clothing and jewelry from the burn area whilst you are cooling it with water.
• Once cooled, cover gently with a dry, sterile bandage.
• If necessary, a child-appropriate medicine containing paracetamol (i.e Panadol or Dymadon) will help to relieve pain from minor burns. Be sure to read the label before using.
• If blisters form on the burnt skin, do not pop them, this will leave the wound susceptible to infection.
• If pain persists beyond a few hours or the skin appears to be becoming infected (oozes or becomes inflamed) consult your family doctor.

Things to avoid when treating burns

• Do not use ice as this can hinder the body’s repair of a burn.
• Do not apply lotions, ointments, butter or powder; rather than improving the injury these make burns worse. By trapping heat in, these substances make the skin burn for longer.
• Avoid rubbing burnt skin, since this makes it more likely to blister.

In an emergency: severe burns

In the event of a severe burn, call emergency services as soon as possibleIn the event of a severe burn (one which is third degree, encompasses more than 10% of the body or causes intense pain), call emergency services as soon as possible – 000 (Australia), 911 (US). While you await their attendance you can assist the child by taking the following measures:

• Put the burnt areas of the body under cold running water as soon as possible (this is beneficial even if it cannot be applied immediately).
• As you cool the skin, quickly remove clothing and jewelry from the burn. If material is stuck to the skin it is important to leave it in place.
• To prevent hypothermia, do your best to keep the child warm – wrap unburned areas of the body in a blanket and increase the temperature in the room to between 28 and 30 degrees celsius (82-86 degrees fahrenheit).
• Elevate the burnt body parts.

Medical treatment of severe burns

The amount of skin injured and the depth of a burn will affect how quickly it heals and whether infection or scarring is likely. Burns are usually treated with special dressings to encourage healing. Sometimes ‘wet dressings’ are used, these are slightly moist and contain silver – an antimicrobial agent – to reduce the risk of infection. It is vital that these dressings are kept clean, dry and in place. A medical professional will manage the checking or changing of dressings and provide the child with suitable pain relief.

It can take several days following a burn to ascertain the extent of the damage and for specialists to determine whether further treatment is necessary. Severe burns often require skin grafting, an operation which involves replacing burnt skin with healthy skin from another site on the body to help those areas heal better.

Long term care of burns

As burns heal, their scars can protrude, become red, sore or itchy and restrict movement. Physiotherapists are often employed to minimise the appearance of burn scars and manage their physical effects.

Along with plenty of fluids and rest, a nutritious, varied diet will help to optimise wound healing. A moisturising lotion, such as glycerine and sorbolene, should be applied to the burn scars a minimum of twice daily. This will enhance the healing process by nourishing the fresh skin, keeping it strong and supple.

Children should be discouraged from scratching their scars as this impairs the repair process and can inflict further damage. Your pharmacist or doctor may be able to recommend moisturisers or antihistamines to reduce the irritation of itchy skin. Sun exposure can further injure burns and burn scars, therefore it is important to keep them covered when spending time outdoors.

Preventing burns

Being aware of potential threats and discussing the risks of burns with your family will help with prevention.Ideally, we want to avoid children receiving burns in the first place. The following safety suggestions may help to prevent an incident from occurring:

• Keep flammable chemicals out of reach of children (preferably in a locked cupboard) and away from flames, sparks and heat.
• Do not allow young children to handle very hot food or drinks.
• Teach children how to avoid the hazards of household appliances such as heaters, ovens and irons.
• If older children are using hot appliances (i.e. sandwich press or hairdryer), show them how to do so safely.
• Ensure your home is fitted with fire blankets, extinguishers and working smoke detectors.
• Prepare a fire plan (including exit routes and meeting points) and practice a drill with your children.
• Make sure that the stove top is never left on unsupervised.
• Store matches and lighters in a safe place where children cannot access them.
• Show children the method of “Stop, Drop and Roll” to put out fire on their own clothes or body.
• Do not allow children near fireworks.
• When cooking with your child, ensure that they only undertake tasks they are capable of performing safely.
• Teach your child about the danger of scalds from hot water when bathing and cooking.
• Decrease the thermostat on your hot water to less than 49 degrees celsius (120 degrees fahrenheit).

References

The Children’s Hospital at Westmead 2011, ‘Burns and Scalds – Burn Care Advice’, retrieved 7 September 2011, < http://kidshealth.chw.edu.au/sites/kidshealth.chw.edu.au/files/fact-sheets/pdf/burns-and-scalds-burn-care-advice.pdf>.

Healthy Children 2010, ‘Treating and Preventing Burns’, retrieved 7 September 2011, <http://www.healthychildren.org/English/health-issues/injuries-emergencies/pages/Treating-and-Preventing-Burns.aspx>.

Healthy Children 2011, ‘First Aid for Burns’, retrieved 7 September 2011, <http://www.healthychildren.org/English/safety-prevention/all-around/Pages/First-Aid-For-Burns.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token>.

The Royal Children’s Hospital Melbourne 2010, ‘Burns-general treatment’, retrieved 7 September 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=11349>.

Bruises are one of the most common and visible injuries, often caused by intense or repeated contact of the skin with another object. Bruises frequently result from falls, accidents or sports injuries, but they may also be indicative of an underlying medical condition. For this reason, parents of children who bruise easily or experience regular, severe or unexplained bruising should seek medical treatment.

What is a bruise?

A bruise is a form of internal bleeding, known medically as a contusion. It is caused when muscle fibres, capillaries and venules (small veins) under the skin are damaged but the skin itself remains intact, causing blood to seep into the surrounding tissue.

The skin around a bruise appears discoloured and is usually more sensitive to touch. Sometimes even light contact will cause pain due to increased pressure on nerve endings within the region, meaning that the body is more receptive to other forms of pressure applied to the area. Bruises typically resolve after approximately two weeks, though additional damage to the area may prolong the healing process.

Colour variation

One of the greatest fascinations with bruises is their change of colour, this is the result of chemical changes in the blood beneath the skin.

Initially bruises appear as red spots, reflecting new blood seeping into the area. As the hemoglobin (a key component in red blood cells) breaks down, it creates new colours in the skin. Firstly a black, blue or purple colour followed by green, yellow and then finally golden brown as the bruise heals. It is quite common for a bruise to have multiple colours at once as the hemoglobin breaks down at different rates in the skin.

Treatment of bruises

Most minor bruises will resolve by themselves over time (normally around two weeks), but it is best to avoid damaging (bumping or prodding) the area further to allow it to heal.A severely bruised elbow. Image: OakleyOriginals on Flickr

The application of a cold compress (ice or ice pack) and raising the affected area immediately following an injury – and for up to 48 hours thereafter – can help to reduce blood flow and thus reduce swelling and bruising. Painkillers, such as paracetamol or ibuprofen, can help to relieve pain caused by more serious bruising.

Extensive bruising could indicate that greater damage has been caused or that an underlying medical condition is contributing to the bruise. In these instances, it is best to seek medical assistance.

Causes of bruising

Certain regular use of medications which thin the blood, including aspirin, can contribute to increased blood flow and more severe bruising. Consult a medical professional if you’re unsure about the effects of a medication.

A number of diseases, including hemophilia, leukemia, thrombocytopenia (low blood platelets), autoimmune diseases (lupus and rheumatoid arthritis), infectious diseases (measles and meningitis) and rarer blood disorders can all cause children to bruise more easily.

References

American Academy of Orthopaedic Surgeons 2007, ‘Muscle Contusion (Bruise)’, retrieved 18 May 2011, <http://orthoinfo.aaos.org/topic.cfm?topic=A00341>.

Robin, S 2011, ‘Diseases That Cause Easy Bruising in Children’, LIVESTRONG.COM, retrieved 18 May 2011, <http://www.livestrong.com/article/105204-diseases-cause-easy-bruising-children/>.

Shiel, WC 2008, ‘Bumps and Bruises (Contusions and Ecchymoses)’, MedicineNet, retrieved 18 May 2011, <http://www.medicinenet.com/bruises/article.htm>.

MedlinePlus 2011, ‘Bruise’, retrieved 18 May 2011, <http://www.nlm.nih.gov/medlineplus/ency/article/007213.htm>.

Mosquitoes, bees, wasps, fleas, spiders and ticks are the most common perpetrators of insect bites and stings in children. The symptoms and extent of the reaction your child experiences following a bite or sting will depend largely on how allergic they are, but most pain and irritation is only temporary.

Often there is only slight, transient inflammation (redness and irritation) of the skin in the spot where the insect has bitten or stung. The bite/sting may be sore, tender or itchy and usually resolves within a few days. More intense reactions involve redness and swelling over a larger area which can take a week or so to settle.

Very occasionally a child can have a severe allergic reaction to an insect bite or sting, known as anaphylaxis. Symptoms may include; dizziness, collapse, widespread hives or rashes, nausea or vomiting, swollen lips or tongue, wheezing, coughing and difficulty breathing or swallowing. Anaphylaxis is a medical emergency; seek immediate treatment for the child as these reactions can be fatal. Some people with known allergies carry an oral steroid drug, such as prednisolone, or an injection of epinephrine (“epi-pen”) to treat anaphylaxis. Ensure you know how to locate and administer these medications if you are caring for a child with acute allergy. A medical alert bracelet may also be useful for teenagers or children who are traveling with other guardians (such as teachers or sports coaches).

Treatment for minor insect bites

To care for mild insect bites at home:

• Gently wash the affected area with clean water
• Apply an ice/cold pack to minimize pain and swelling (be sure to wrap this in a cloth to prevent skin burn)
• Apply calamine lotion several times each day to ease itchiness and try to stop your child from scratching when possible
• Where necessary, oral antihistamines can be given to reduce the skin reaction. Over-the-counter antihistamine medications containing promethazine hydrochloride or cetirizine hydrochloride are usually effective. It is important to speak with your chemist about the particular medication and dose appropriate for your child, as these vary with age.
• Application of topical steroid creams may also provide your child with some relief; however these often require a prescription from your doctor or discussion with your chemist.
• Administration of a mild painkiller such as paracetamol or aspirin may help with painful bites.

If an extreme reaction occurs, symptoms persist for longer than a week or the skin becomes infected, seek professional medical advice.

Bee and wasp stings

A bee sting. Image: Waugsberg from Wikimedia commonsGetting stung by a wasp or bee is quite painful and can cause swelling, which may increase over the following 24 hours. Stings are usually sore for several hours and swollen or itchy skin may last for up to a week.

To treat a bee or wasp sting:

• A bee leaves its stinger in the skin, remove this as quickly as possible. Stingers contain venom and the longer a stinger is in place, the more venom will be injected.
• Press a wrapped ice pack onto the affected area to minimise the pain and swelling.
• If the reaction persists for longer than a week or spreads over a large area, consult a medical professional.
• You will need to take the child to hospital if they have been stung a number of times.

Bee and wasp stings can sometimes cause the extreme reaction, anaphylaxis, if the child is allergic to proteins in the venom. If a child’s lips or tongue begin to swell or they experience trouble breathing or swallowing, seek emergency medical assistance.

Preventing insect bites

Outside

Mosquito nets can help protect you from insect bites. Image: FlickrLickr from Wikimedia commonsInsect repellents are an effective way to prevent insect bites when outdoors, though should be applied in moderation. DEET (N,N-Diethyl-meta-toluamide) is the most commonly used active ingredient in insect repellant. Products with a concentration of less than 10 percent are safe for use on children’s skin, however the ingredient should not be used on infants less than two months.

Physical barriers such as mosquito nets are useful when sleeping outdoors or camping, netting can also be fitted to prams. It is a good idea to keep food and rubbish contained to avoid attracting insects (such as ants and wasps); heavily scented soaps, deodorants or perfumes may also entice them. Additionally, you can cover your child’s exposed skin with long pants and tops to protect their skin.

Inside

Close windows before turning on lights in a room (this attracts insects) and have screens fitted to open doors or windows. Aerosols containing insecticide can be used to deal with individual insects and automated units can be used to control insects in the home. These devices should be operated in open, ventilated spaces away from children’s regular activities.

References

The Royal Children’s Hospital Melbourne 2010, Insect bites and stings’, retrieved 14 March 2011, <http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=3729>.

Sydney Children’s Hospital n.d., ‘Factsheet – Bites and stings’, retrieved 14 March 2011, <http://www.sch.edu.au/health/factsheets/joint/?safbitej.htm>.